The COVID-19 pandemic and its consequences for the diagnosis and therapy of head and neck malignancies.

OBJECTIVE: The COVID-19 pandemic and the measures accompanying it have been accused of having a negative influence on the frequency and methods of treatment of various diseases including head and neck cancer (HNSCC). To go further into this assumption, the diagnoses made, and treatments performed at one of Germany's largest head and neck cancer centres were evaluated. PATIENTS AND METHODS: This study consisted of one single centre and involved a retrospective review of all patients with newly diagnosed or recurrent HNSCC. The diagnosis and treatment methods used in the pre-COVID-19 time period between March 1st, 2019, and March 1st, 2020, were analysed and compared with the COVID-19 time period from April 1st, 2020, until April 1st, 2021. The primary objective was defined as the number of malignant diagnoses and the secondary objectives as the disease stage and the time to therapy. RESULTS: A total of 612 patients (160♀; mean 63 yrs.) were included. 319 patients (52%) were treated in the pre-COVID-19 time. The two groups did not differ in terms of age (p=0.304), gender (p=0.941), presence of recurrent disease (p=0.866), tumour subsite (p=0.194) or the duration from presentation to the multidisciplinary tumour board until start of therapy (p=0.202). There were no significant differences in the T stage (p=0.777), N stage (p=0.067) or UICC stage (p=0.922). During the pre-COVID-19 period more patients presented with distant metastases (n= 23 vs. n=8; p=0.011). CONCLUSIONS: This study shows that there was no significant change in either the number and severity of HNSCC diagnoses or the time until start of therapy at this large head and neck cancer centre as a result of the COVID-19 pandemic.

Severe escalation of out-of-hospital cardiac arrests in sars-cov-2-immersed metropolitan cities

INTRODUCTION: Following COVID-19 stay-at-home directives in March 2020, many EMS systems worldwide observed 30- 40% decreases in total call volumes. Simultaneously, most metropolitan cities severely impacted by COVID-19 also reported marked increases in out-of-hospital cardiac arrest (OHCA) cases. The study aim was to quantify the change in OHCA numbers observed in large urban centers during the onset of the COVID-19 crisis. METHODS: Major city EMS systems covering ∼one-quarter of the U.S. population (n=45), and millions of others in major European/Australian cities, were surveyed for their monthly EMS OHCA numbers during the first 6 months of 2020. Data were compared to averaged corresponding monthly periods in 2018 and 2019. Considering normal variation and the complexities of OHCA cases (risk, significant personnel/resource utilization and protracted time away from other 9-1-1 responses), >10% increase/decrease was considered, a priori, a highly significant difference, especially in terms of operational impact. RESULTS: Of the 45 major U.S. cities studied, large escalations in OHCA were associated with the relative prevalence of COVID-19. During April, 32 cities with high rates of COVID-19 had >15% increases in OHCA vs. prior years. Among 13 cities with >50% (1.5-fold) increases, 3 widely recognized COVID-19 epicenters had >double their usual OHCA numbers (2.5-fold in NYC). Conversely, despite lockdowns, cities with relatively lower COVID-19 cases, had no change from prior years (n=6) or even fewer cases (n=6). Inclusive of all 45 cities, the mean number of OHCA cases/city rose in April by 62%, from 149 to 241 (p=0.037). By June, cities with the highest rates of OHCA, like NYC, returned to or approached pre-COVID levels after mitigating spread, while initial low impact cities with lower OHCA rates in April (eg, Phoenix, Charleston) experienced marked increases in June as local COVID-19 cases rose substantially. European/Australian cities mirrored the U.S. experience. CONCLUSIONS: Metropolitan cities have experienced marked increases in OHCA during 2020 paralleling the prevalence of COVID-19 in their respective jurisdictions placing significant operational strains on affected 9-1-1 systems. These on-going observations are now part of a work in progress to elucidate the underlying etiologies.

80 Los Angeles Fire Department Telemedicine Program: An Emergency Dispatch Center Based Pilot

Study Objectives: The Los Angeles Fire Department (LAFD) has experienced an unprecedented growth in 911 calls for emergency medical services (EMS), including a disproportionate growth among low-acuity 911-callers. Managing these low-acuity calls is even more critical in the era of COVID-19 (CV19) where EMS over-utilization puts both EMS providers and patients at risk. The LAFD Telemedicine Program (LTP) integrates advanced providers (AP) (nurse practitioners, physician assistants, and emergency physicians) into the Los Angeles Tiered Dispatch System. 911 callers between the ages of 2 and 64 years old with low-acuity complaints and no priority symptoms are transferred from the emergency medical dispatcher to the AP. Through a telemedicine platform, the AP can perform an assessment and release the patient without dispatching field emergency resources or dispatch the appropriate EMS field resource or a taxi to transport the patient to an emergency department (ED) or alternative destination. The objective of this pilot study is to describe the initial experiences of this novel program. Methods: This is a 2-month retrospective review from April 6 to May 31, 2020 of electronic medical records for 911-calls that were referred to LTP. Additionally, all patients who received care through LTP were contacted within 24 hours via phone to evaluate the need to access further emergency care through 911 or an ED and to assess their overall satisfaction. The primary outcome is the disposition of patients who were triaged to the LTP. Secondary outcomes include the need for further emergency care, and patient satisfaction. Descriptive statistics are used. Results: During its first 2 months of service, the LTP attended 159 patients, of whom 49 (30.8%) were treated via telemedicine alone and no resources were dispatched (“No Send”);9 (5.6%) were sent for further care via taxi;and 101 (63.4%) were dispatched and evaluated by EMS providers on scene. Of these 159 patients, 94 (59.1%) completed a brief phone survey. No patients reported accessing further emergency care through 911 or an ED after their LTP encounter. Overall, the mean satisfaction score of care provided by the LAFD was 9.3 out of 10. As a result of LTP intervention, 58 LAFD field resources remained available for the next time-critical call, >100 sets of PPE were preserved, and countless potential CV19 exposures were avoided. Conclusion: Preliminary data suggests that dispatch-initiated telemedicine with a “No Send” option can be safely integrated into EMS systems to preserve emergency resources, reduce exposure of field medical providers, and provide quality care for low-acuity calls. Further, larger studies are needed to evaluate safety and efficacy.